Suture throw rundown tool

Abstract

An improved suture throw rundown tool particularly useful in laparascopic and similar surgical procedures is provided which includes an elongated shaft having a proximal end and a first distal tip, an elongated rod extending through the shaft in reciprocating relation therewith and having a proximal end and a second distal tip, and a control device connected between the shaft and the rod for controlling the relative disposition of the first and second distal tips. The first and second distal tips are specially designed to mate with each other in a first position and to be longitudinally offset relative to each other in a second position. In the offset position, a suture throw may be engaged by the distal end of one of the distal tips while the free ends of the suture emanating therefrom are extended through grooves connecting the distal end of the offset distal tip to its outer edge. Movement of the distal tips from their offset configuration to their aligned configuration provides a distally facing suture throw engagement portion flanked by closed passageways for the free suture ends emanating from the suture throw which prevent dislodgement of the throw from the tool during the rundown operation. A capability for trimming free suture ends emanating from a completed surgical knot at an internal surgical site are also provided.

What is claim is: 
     
       1. A method of running a suture throw down free ends of suture extending from an operative site into engagement with the operative site, comprising the steps of: (a) providing a suture throw rundown tool comprising: a handle;   an elongated shaft having a longitudinal axis, a proximal end and a first distal tip having a first distal end, said shaft defining a hole therein substantially adjacent said proximal end, and said proximal end being located within and fixedly attached to said handle;   a rod having a proximal end and a second distal tip having a second distal end, said rod extending through said shaft in reciprocable longitudinal relation therewith;     helical spring means having a first end and a second end located within said shaft substantially adjacent its proximal end;   pin means extending through said handle and said hole in said shaft so as to secure said shaft to said handle, said first end of said spring being attached to said pin and said second end of said spring being attached to said proximal end of said rod; and actuation means for moving said rod relative to said shaft between a proximalmost position and a distalmost position;   said first and second distal tips being so configured as to mate with each other in longitudinally reciprocal relation such that: (i) when said rod is in said proximalmost position, said first distal end of said first distal tip and said second distal end of said second distal tip are aligned with one another, and said first and second distal tips together define a distally facing suture throw engagement portion flanked by a pair of passageways, each of said passageways (a) being sized to receive a length of suture in sliding relation therethrough, (b) extending respectively from said suture engagement portion at an acute angle to said longitudinal axis through said mated, aligned first and second distal tips, and (c) being formed by the alignment of a first portion located in said first distal tip and a second portion located in said second distal tip; and   (ii) when said rod is in said distalmost position, said second distal end of said second distal tip is offset distally relative to said first distal end of said first distal tip by a distance at least equal to the length of said passageways measured along said longitudinal axis;       (b) forming a suture throw in the free ends of suture extending from an operative site;   (c) manipulating said actuation means so as to place said rod in its distalmost position;   (d) engaging said throw with said second distal end of said second distal tip and placing said free suture ends extending from said throw respectively into passageway portions flanking said second distal end of said second distal tip;   (e) manipulating said actuation means so as to move said rod from said distalmost position to said proximalmost position, thereby slidably capturing said free suture ends extending from said throw respectively in said flanking passageways and engaging said throw with said throw engagement portion formed by said first and said second distal tips;   (f) running said throw down said suture ends extending from said operative site to said operative site;   (g) manipulating said actuation means so as to move said rod to its distalmost position and releasing said free ends of suture extending from said throw from said second passage forming portions; and   (h) repeating steps (b) through (g) as many times as necessary to complete the formation of the desired surgical knot at the internal surgical site.   
     
     
       2. A method according to claim 1 wherein said shaft further defines an opening located distally of said hole, said handle defines an open slot and said actuation means comprises a trigger assembly pivotally mounted to said handle in said slot on a second pin, said trigger assembly comprising a trigger and a projection extending from said trigger so as to engage said rod such that a force directed inwardly against said trigger will rotate said trigger about said second pin and cause said projection to urge said rod toward its distalmost position. 
     
     
       3. A method according to claim 1 wherein: said first distal tip defines first and second recessed portions on opposite sides of said first distal end, and a first substantially planar mating surface having a pair of spaced first projections extending normally outwardly therefrom adjacent said first distal end; and   said second distal tip defines a second substantially planar mating surface having: (i) a pair of spaced longitudinal slots therein extending proximally from said second distal end;   (ii) a pair of second projections extending normally outwardly therefrom, said projections being located on opposite sides of said surface immediately adjacent said second distal end; and   (iii) a pair of grooves, each said groove extending from said second distal end to an adjacent side edge of said second mating surface substantially immediately proximally of one of said second projections.     
     
     
       4. A method according to claim 1 wherein said first distal end and said second distal end define corresponding slots extending proximally from said first and second distal ends respectively to proximal slot ends, said slots each being located normal to both the distal end and the substantially planar mating surface of its associated distal tip, and a cutting blade having a cutting edge is fixedly disposed between said first and second distal tips such that said cutting edge extends distally of said proximal ends of said slots, and including the step after step (h) of drawing said free suture ends extending from said knot into said corresponding slots and severing same with said cutting edge. 
     
     
       5. A method according to claim 4 wherein said second distal tip is hingedly attached to said rod and a sleeve member closely surrounds said tool, said sleeve being movable between a first position closely surrounding said first and second distal tips and a second position located proximally of said hinged attachment of said second distal tip to said rod. 
     
     
       6. A method according to claim 5 wherein said suture rundown tool further comprises means for releasably locking said sleeve in said first or said second position. 
     
     
       7. A method according to claim 6 wherein said locking means comprises a distally facing shoulder extending around said shaft, a proximally facing shoulder extending around said mated first and second distal tips when said first and second distal ends of said first and second distal tips are aligned with each other, said proximally facing shoulder and said distally facing shoulder being longitudinally separated from each other by a longitudinal distance slightly greater than twice the axial length of said sleeve, and flexible projecting means extending radially outwardly from said first distal tip proximally of said hinged attachment of said second distal tip to said rod when said first distal end of said first distal tip is aligned with said second distal end of said second distal tip such that said sleeve may be forced from a first position engaging said proximally facing shoulder over said flexible projection to a second position engaging said distally facing shoulder and vice versa. 
     
     
       8. A suture throw rundown tool comprising: a handle;   an elongated shaft having a longitudinal axis, a proximal end and a first distal tip having a first distal end, said shaft defining a hole therein substantially adjacent said proximal end, and said proximal end being located within and fixedly attached to said handle;   a rod having a proximal end and a second distal tip having a second distal end, said rod extending through said shaft in reciprocable longitudinal relation therewith;   helical spring means having a first end and a second end located within said shaft substantially adjacent its proximal end;   pin means extending through said handle and said hole in said shaft so as to secure said shaft to said handle, said first end of said spring being attached to said pin and said second end of said spring being attached to said proximal end of said rod; and   actuation means for moving said rod relative to said shaft between a proximalmost position and a distalmost position;   said first and second distal tips being so configured as to mate with each other in longitudinally reciprocal relation such that: (i) when said rod is in said proximalmost position, said first distal end of said first distal tip and said second distal end of said second distal tip are aligned with one another, and said first and second distal tips together define a distally facing suture throw engagement portion flanked by a pair of passageways, each of said passageways (a) being sized to receive a length of suture in sliding relation therethrough, (b) extending respectively from said suture engagement portion at an acute angle to said longitudinal axis through said mated, aligned first and second distal tips, and (c) being formed by the alignment of a first portion located in said first distal tip and a second portion located in said second distal tip; and   (ii) when said rod is in said distalmost position, said second distal end of said second distal tip is offset distally relative to said first distal end of said first distal tip by a distance at least equal to the length of said passageways measured along said longitudinal axis.     
     
     
       9. A suture rundown tool according to claim 8 wherein said shaft further defines an opening located distally of said hole, said handle defines an open slot and said actuation means comprises a trigger assembly pivotally mounted to said handle in said slot on a second pin, said trigger assembly comprising a trigger and a projection extending from said trigger so as to engage said rod such that a force directed inwardly against said trigger will rotate said trigger about said second pin and cause said projection to urge said rod toward its distalmost position. 
     
     
       10. A suture rundown tool according to claim 8 wherein: said first distal tip defines first and second recessed portions on opposite sides of said first distal end, and a first substantially planar mating surface having a pair of spaced first projections extending normally outwardly therefrom adjacent said first distal end; and   said second distal tip defines a second substantially planar mating surface having: (i) a pair of spaced longitudinal slots therein extending proximally from said second distal end;   (ii) a pair of second projections extending normally outwardly therefrom, said projections being located on opposite sides of said surface immediately adjacent said second distal end; and   (iii) a pair of grooves, each said groove extending from said second distal end to an adjacent side edge of said second mating surface substantially immediately proximally of one of said second projections.     
     
     
       11. A suture rundown tool according to claim 8 wherein said first distal end and said second distal end define corresponding slots extending proximally from said first and second distal ends respectively to proximal slot ends, said slots each being located normal to both the distal end and the substantially planar mating surface of its associated distal tip, and a cutting blade having a cutting edge is fixedly disposed between said first and second distal tips such that said cutting edge extends distally of said proximal ends of said slots. 
     
     
       12. A suture rundown tool according to claim 11 wherein said second distal tip is hingedly attached to said rod and a sleeve member closely surrounds said tool, said sleeve being movable between a first position closely surrounding said first and second distal tips and a second position located proximally of said hinged attachment of said second distal tip to said rod. 
     
     
       13. A suture rundown tool according to claim 12 further comprising means for releasably locking said sleeve in said first or said second position. 
     
     
       14. A suture rundown tool according to claim 13 wherein said locking means comprises a distally facing shoulder extending around said shaft, a proximally facing shoulder extending around said mated first and second distal tips when said first and second distal ends of said first and second distal tips are aligned with each other, said proximally facing shoulder and said distally facing shoulder being longitudinally separated from each other by a longitudinal distance slightly greater than twice the axial length of said sleeve, and flexible projecting means extending radially outwardly from said first distal tip proximally of said hinged attachment of said second distal tip to said rod when said first distal end of said first distal tip is aligned with said second distal end of said second distal tip such that said sleeve may be forced from a first position engaging said proximally facing shoulder over said flexible projection to a second position engaging said distally facing shoulder and vice versa.